760 Ind. Admin. Code 3-2-4.6

Current through October 31, 2024

Section 760 IAC 3-2-4.6 - "Creditable coverage" defined

Authority: IC 27-8-13-9; IC 27-8-13-10; IC 27-8-13-10.1

Affected: IC 27-8-13-1

Sec. 4.6.

(a) As used in this rule, "creditable coverage" means, with respect to an individual, coverage of the individual provided under any of the following:

(1) A group health plan.

(2) Health insurance coverage.

(3) Part A or Part B of Title XVIII of the Social Security Act (Medicare).

(4) Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under Section 1928.

(5) Chapter 55 of Title 10, United States Code (CHAMPUS).

(6) A medical care program of the Indian Health Service or of a tribal organization.

(7) A state health benefits risk pool.

(8) A health plan offered under Chapter 89 of Title 5, United States Code (Federal Employees Health Benefits Program).

(9) A public health plan as defined in federal regulation.

(10) A health benefit plan under Section 5(e) of the Peace Corps Act (22 United States Code 2504(e)) .

(b) The term shall not include one (1) or more, or any combination of, the following:

(1) Coverage only for accident or disability income insurance, or any combination thereof.

(2) Coverage issued as a supplement to liability insurance.

(3) Liability insurance, including general liability insurance and automobile liability insurance.

(4) Workers' compensation or similar insurance.

(5) Automobile medical payment insurance.

(6) Credit-only insurance.

(7) Coverage for on-site medical clinics.

(8) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

(c) The term shall not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan:

(1) Limited scope dental or vision benefits.

(2) Benefits for long term care, nursing home care, home health care, community-based care, or any combination thereof.

(3) Such other similar, limited benefits as are specified in federal regulations.

(d) The term shall not include the following benefits if offered as independent, noncoordinated benefits:

(1) Coverage only for a specified disease or illness.

(2) Hospital indemnity or other fixed indemnity insurance.

(e) The term shall not include the following if it is offered as a separate policy, certificate, or contract of insurance:

(1) Medicare supplemental health insurance as defined under Section 1882(g)(1) of the Social Security Act.

(2) Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code.

(3) Similar supplemental coverage provided to coverage under a group health plan.

760 IAC 3-2-4.6

Department of Insurance; 760 IAC 3-2-4.6; filed Feb 1, 1999, 10:45 a.m.: 22 IR 1972; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; readopted filed Nov 27, 2007, 4:01 p.m.: 20071226-IR-760070717RFA; readopted filed November 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFA

Readopted filed 11/20/2015, 9:25 a.m.: 20151216-IR-760150341RFA

Readopted filed 11/15/2021, 8:32 a.m.: 20211215-IR-760210419RFA